MEDICARE: DR. JASON JOUNGWOO NAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2017-01885	NC
2	208D00000X	General Practice Physician	0101256785	VA
3	207RP1001X	Pulmonary Disease Physician	2017-01885	NC

General Provider Information

NPI Number	:	1689013054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON JOUNGWOO NAM M.D.

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-0010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRIT AVE
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-1231
Country	:	US
Telephone Number	:	910-907-7369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	03/05/2024

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